HomeMy WebLinkAboutPermit Electrical 1995-9-18
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ELECTRICAL PERMIT APPLICATION
97477 esn P d '1"^OJdda
. u uBlo!l!oe S ol!nboJ 10U Soop CUB .8"..,1")....
72{}-~~ e41 S"4 pell!wqns SelOe!oJd 5U!MOII~~U' Job Number -9,~ Y4f{;z
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
-::2',7?~~~r,hlP./C ?,7
LEGAL DESCRIPTION
1?-d3-2~o// .~~
,
JOB DE~PTION &
~.t..c.-__ k? 4'~~ 'AtbJ!> ~
-
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
\ ,
2. CONTRACTOR INSTALLATION ONLY
Electrical contractor~~
Address
City
Phone
Supervisor License Number
Expiration Oate
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name 7~.N~ L ~,....NF D.
Address -2?~ c:!>~ ~;>>....e: ~ #
City ?~~ Phone -:J'sI/-q/.:J/
- , ~/'I ""?
01lNER INSTALLATION
)'
The installation is being made on
property I ovn which is not intended
~or sale, lease or rent.
Owners ~ature:
./ 1'57' . -d L-
---~-----------~-----------------------
.....,.../~"'7s-
RECEIPT II: /~,pq
RECEIVED BY: - /.7~~"" ~
DATE:
3. COMPLETE FEE SCHEDULE BELOV
A. New Residential-Single or
Multi-Family per dwelling
Service Included:
Items
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home, or
Modular 'Dvelling
Service or Feeder ~
B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
uni t.
Cost Sum
$ 85.00
"
$ \~.OO
$ 40'.00 ~.-
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps' 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Branch Circuits
$ 40.00
$ 55.00
$ 80~00
see "B" above
.'
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permit
$ 35.00
$ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE ~.~
5% State Surcharge ~.~
3% Administrative Fee :7. ~
TOTAL Q. ~. yt:::'
/
. JOB NO. "15 Nt:.2
CITY OF SPRINGFIELD SYSTEMS DEVELOP~T CHARGE
WORKSHEET
.
.
NAME OR COMPANY:
Uj>.14 DeN
/"Io~St
LOCATION: 2750
OL~fo'\P(c...
ST.
DEVELOPMENT TYPE: tltj.J "'A04uFA,-T"~O J.jCMe. 1# 8Mk or
J.CI-IJ.l~'S C/fI3IHC-r SHoP
BUILDING SIZE:
LOT SIZE
SQ. Ft,
1, STORM nRAfNAGE
(loa.. ,;.(,
/'-^' -....
, I
IMPERVIOUS SQ. FT. ,10/' ~ 27
X $0.21 PER SQ. FT.
(('Z'I9 ~
......... ./
2. ~ANTTARY S~NFR-rTTY
NO. OF PFU'S
(See Reverse)
Ie
X $43,43 PER PFU
G ibl-r~
......... ----
3. TRANSPORTATT.ill!
NO OF UNITS X TRIP RATE X COST PER TRIP
X I.~\' X $437.93
~'-t23.!...)
.......... --
x X $437.93
$
x X $437.93
$
4. SANTTARY SFWFR-MWMr
NO. OF PFU'S x $lB.75 PER PFU + $10 MWMC ADMIN,FEE
(Use PFU Total From Item 2 Above)
$
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAl -MWMr snr.
5. ADMINTSTATTVF FFFS
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
$
~
$/,'/1':l,~
BASE CHARGE (SUBTOTAL ABOVE) X .05
C731f~ ""')
.......... ----
~"\ I"-'AL'-I $rt/2.
Troy MeA 11 i ster
SDC Coordinator
Date:
~ /18/"15
r
TOTAl snr
,I
$ L 5'1"" "-'
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I I^ I VrlL U..... I """,",,,-,,,,va-,..,, I.....,.." . r"\u....... l'lUIIIUt:r UI l'.tt::W /",IX[ureS ^ unn: tqulvalent = f"'lXn.;P:! UfUtS
INOTE: For remodels, calculate only the NET additional fixtures) _'
. NUMBER 0
FIXTURE TYPE NEW FIXTU
Bathtub,.".....,..........,.....................,.......................... .
Drinking Fountain...............................................,.....
Floor Drain..,.............................................................
Interceptors For Grease/Oil/Solids/Etc.................
Interceptors For Sand/Auto Wash/Etc..................
Laundry Tub/Clotheswasher...................................
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap 11 Per Trailerl..................
Receptor For Refrigerator/Water Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stall.................................................
Shower, Gang....... ...................................................
Sink: Bar, Commercial, Residential Kitchen........................
Urinal, Stall/Wall. ......................................................
Wash Basin/Lavatory, Single..................................
Toilet, Public Installation........................................
Toilet, Private...................... ;................................
Miscellaneous:
z.
':!
'7
TOTAL FIXTURE UNITS
UNIT
EQUIVALENT
2
1
2
3
6
2
6
6
1
3
2
l/Head
2
2
1
6
4
=
F.IXTURE
UNITS
2
'7
'Z.
(>,
18
.
.
t.j
CREDIT CALCULATION TABLE: Based on assessed value, If improvements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
I
I,
,
1979 or before
1980
1981
1982
1983
1984
1985
1986
$3.47
3.39
3.33
3.21
3.06
2.92
2.74
2.46
1987
1988
1989
1990
1991
1992
1993
1994
L
Credit for Parcel or Land Only If Applicable
X $
(Rate X Assessed Value)
X $
IRate X Assessed Value)
Improvement (if alter annexation datel
=
=
CREDIT TOTAL = $
Rate per $1,000
Assessed Value
$2.13
1.76
1.35
0.95
0.58
0.41
0.29
0.14
"
II
/
.
DEVELOPMENT SERVICES DEPARTMENT
225 FIFTH STREET
SPRINGFIELD, OR 97477
(503) 726-3753
FAX (503) 726.3689
MANUFACTURED HOME SET-UP AGREEMENT
As required by the City.of Springfield Development Code, I understand and agree
that with the approval of the attached permits, one of the followi~
manufactured homes will be placed at ;?"/.?,p tOl:v-~~4:" ~ ~
Springfield, Oregon, City Job Number <9 ~/'7h'? '. '
\I Type I Manufactured Home. A multi-sectional (double wide or wider)
unit with an enclosed tloor area of not less than 1,000 square feet,
that has a nominal roof pitch of 3 feet in height for each 12 feet in
width, that has no bare metal siding or roofing, and that has been
certified by the manufacturer to have an exterior thermal envelope
meeting performance standards which reduce heat loss to levels
equivalent to the performance standards required of single family
dwellings IWnstrn~<e'; .;..dc ~h2. ::.;:::: ~pee4.a'''' ("'~
(U -\~ ~ 9:> Co(\ ~-Th.u.d:\CJi'.
Trpe II Manufaotured Home. A unit of not less than 12 feet in width
wlth an enclosed tloor area of not less than 500 square feet, that has
a nominal roof pitch of 2 feet in height for each 12 feet in width and
that has no bare metal siding or roofing.
I further state, by my signature below, that I have been provided with the
following information:
_ Manufactured Home blocking
- Yater line connection
- Street tree standards
- Sanitary sewer connection
- Electrical connection
_ Minimum requirements for permanent steps
I also understand that if I am installing a Type I Manufactured Home, the home
shall be enclosed at the perimeter with stone, brick or other masonry materials,
and with no more than 12 inches of the enclosing material exposed above grade.
'-jr/~ /~
Signature
9-//? -?"S--
Date
I
. .
Permit#: a-5/%z
,~ ,
Address: _ 2?5i!7 ~c_~~/'C ~ .
ISSUedby:4~ Date: ~~7S--
'/~- .- ...
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction pennit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building pennit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing penn its. Licensed
architect and engineer applicants, exempt from registration under ORS 701,010(7),
need not submit this statement. This statement will be filed with the pennit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
IZJ
D
I. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
D
3A. My general contractor is
(Name) Contractor regis, #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
I)ZI 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners a~onstruction Responsibilities on the reverse side of this form.
~ -~ A ;PY{""-?r,-
(Signature of permit applicant) (Date)
v
(White copy to issuing agency permit file,
pink copy to applicant)
.
.
1
'-
JIn1ormatlon'i\lotice to Property Owners
About Construction Responsiroili~ies
.. . ~ -..
Note: This Information Notice to Property Owners about Construction Responsibilities
was developed by the Construction Cimrractors Board in accordance with ORS 701,055(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees, As the employer, you must comply with the following:
Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees
are paid, You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Depl. of Revenue at 945-8091,
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources
at 378-3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law. and must
obtain workers' compensation insurance for your employees, If you fail to obtain workers' compensation insurance, you may
be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal Revenue Service: As an employer, you must witbhold federal income tax from employees' wages, You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections,
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done,
Time to supervise employees: Make sure you have sufficient time to supervise your employees,
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem. OR 97309-5052,
503/378-4621). The Board is located at 700 Summer SI. NE Suite 300. in Salem.
prop-own.pm4
1/94
RESIDENTIAL
PERMIT APPLICATION
.
SPRINGFIELD
Inspections: 726.3769
qffice: 726.3759
\
LOCATION OF PROPOSED WORK: _,27 SO r)~V m ,IN ('
ASSESSORS MAP: S e (' ? _,,~ - T~ 1':7 S, 12. '3 w
f.) 1/--P~'5""~'
LOT:--1,rl<.l?r-h BLOCK:
OWNER*' -~ fS('PL~ ,.\,,,," L,
ADDRESS: ,- ?-. 7 S-Ci 0 I V fr1 fl " c:..
CITY: C;Pf'{r-.c, C'< e L.t
.
9~/ V..?:?_
JOB NUMBER
225 Fifth Streel
Springfield, Oregon 97477
..97c -e-- f-
/.u;.."
TAX LOT:
.c?~ ~~
SUBDIVISION:
m,..,V'~"",
sf-
, STATE: 0 re. q(3 ')-
-
PHONE:_7'-1 J - yzz/
_ ZIP:
c; 7Lf??
DESCRIBE WORI(: -bJ J4.p.J t<. t'1I-rl-,A Ke
NEW
REMODEL
CONTRACTOR'S NAME
li~nN
GENERAL:
PLUMBING: ~~
MECHANICAl'
ELECTRICAL:
r;q ul ~K-
/~C"
ADDITION
DEMOLISH
OTHER
ADDRESS
L-..lJJ'et1.s ~
/ }n/VIV~
CONST,
CONTRACTOR'
L'~~r-
PHONE
..J:H" A./;.".""
QUAD AREA: _ -:2.7:,4/ hP'
. OF BLDGS: __
QCCY GROUP:
. OF STORIES:
-
;t?-3'
/
WATER HEATER:
- OFFICE USE _
LAND USE:
. OF UNITS:
CONSTR, TYPE:
HEAT SOURCE:
M'~~~~
CCE'C:r .A"~_
EXPIRES
5:4...... "
FLOOD PLAIN:
ZONING CODE: !' M r
. OF BDRMS'
. ,
SECONDARY HEAT:
SQUARE FOOTAGE: _
RANGE'
To roquest an Ins pee lion, you must call 726.3769, This ts a 24 hour recording, Alllnspecllons requesled belore 7:00 a,m, will be
made the SOOle working any. Inspectlons requested ofter 7;00 a.m. will bo made tho followIng work day.
o Tompornry Electric
o Slto Ins pee lion - To be mado
after excavation. bul prior to
selling forms.
o Underslllb Plumblng/Electrical/
Mechanical - PrIor 10 cover.
o Fooling - After trenches are
excavated.
o Masonry - Steel location, bond
beams, groutlng.
o Foundation - AHer forms are
erected but prior to concrete
placement.
o Undorground Plumbing - Prior
to fllllnQ Irench,
o Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Post and B08~ - Prior to floor
Insulation or docldng.
o Floor Insulation - Prior to
decking,
o Sanitary Sewer - !"rlor to (Wing
trench.
o Storm Sewor - Prior to rUling
trench.
o Water Line - Prior to IIl1ing
lrench. "
o Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
0" Rough Eleclr~cal - Prior to
cover. .
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior 10 facIng
materials and framing Insp.
o Fram.lng - Prior to cover.
.0 Wail/Ceiling Insulation - Prior to
cover. .
o Drywall - Prior to taping,
o Wood Slovo - AHcr Installation.
o Inserl - After fireplace approval
and Installation of unll. .
o Curbcu! & Approach - After
forms Brc erected but prior 10
placomont of Concrutc.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub.base malerlal in place,
o Fence - When com~leled.
o Slreol Troos - Whon al/ required
trees are planted.
o Final Plumbing - Whon 011
plumbing worl( Is comptele.
-, ,
o Final Eloctrlcal - When all
electrical work Is completo.
o Final Mechanical - When all
mechanical work Is complete.
o Final Building - When all
required Inspoctlons have boon
approved and building Is
complotod.
lZl Othor .<Lh ~....~~.. -ri'""_':-
t:/h'?A-~':: 5~:-
/'~-'7~~.
MOBILE HOME INSPECTIONS
11/1 Blocking and Set.Up - When all
L..aJ blocking Is complete.
[At Plumbing Connections - When
home has been connected to
waler and sewer.
rM' Electrical Connoctlon _ Whon
~ blocking, set.up, and plumbing
lnspecllons have beon approvOd
and the home Is connected 10
the service panel.
~ Final - After all required
Inspections are approved and
porches, skirting, docks, and
venting havo boon Installod.
Lot faces Lot Type.
I RL,
Lot sq, ltg, - Interior IN
Lot coverage Corner
Is
Topography Panhandle
Iw
Total height Cul.de.sac
IE
BUILDING PERMIT
ITEM SO, FT. X
1211:1./" '1 '1'1<+)
$/SO, FT.
I )'77:i
,
Main
Garage
Carport
~JJ
Tolal Value
Building Permit Fee
State Surcharge
Total Fee
(A)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bathls) N'
Sanitary Sewer FT, I~'
Water FT, /~
Storm Sewer FT,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permi t
Issuance
Slate Surcharge
TOlal Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
~
Slale Surcharge
Sidewalk
It
Curbcut
II
Demolition
State Surcharge
Tolal Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
{$
,; .
-
__ THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
" yes, this application must be signed
and approved by Ihe Historical
Coordinator prIor to permit issuance.
Setbacks
HSE GAR Accl
I
VALUE
'J. <1/ 1'1(,
"
t1 J (-00 "-"-'
,
FEE
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t./.?
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9-'? '-~
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APPROVED:
,
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permIt 15 granted on the express condition that the said
construction shall, In all respects, conform 10 the Ordinance
adopted by the City 01 Sprlngllele!, including the
Development Code, regulaling the cOQ.lruction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of sold ordinances.
Plan Check Fee: _....L'6.. ~ S-
Date Pald:,__,'5J-J//:::97 _
Receipt Numbel:....!-6,.?O___.,
,.....-:) . --'~ '"=.?'- <-
Received By:
Plans Revlcwed'8y--'.-"'--'--
Date
Systems Development Charge Is due on all undeveloped
properties within tho City limits which are being Improved,
ADDITIONAL COMMENTS
vY. ,7'~~.d~_v.......-~
r./~""'f~':'-~"95/~-~ .~
/ ~c:"::z.z.if~c~
-, ..
oX/.tv l~ __
\ MJil f~t 'lktl'w\-
~/
, I
~
. By signature, I state and agree, that I have carefully examined
the completed appllcallon and do hereby cortlfy that all
Information hereon Is true and correct, and I further certlfy
that any and all work performed shall be done In accordance
with the Ordlnancus of tho City of Springfield, and the Laws
of the Stato of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made 01 any
structure without permission of the Bulldif'lg Safety Dlvislo"n.
I further certify that only contractors and employees who
are In compliance with ORS 701.055 will be used on this
prolect,
I further agree to ensure that all required Inspections ars
requested at the propor lime, thai each address Is readable
from the street, that the permit card Is located at the front
of the property, and the approved set of plans wilt remain
on the site at all ~s during construction,
Signature "j1"~,.,. ,~ ~
.......-
c;l- /x= - 9f-
Date
VALIDATION:
RECEIPT NUMBER
/"700:::: ::>
~./R~~
DATE PAID
AMOUNT RECEIVED _~ 9c&'..c:;/
.. RECEIVED BY ~.It' --,. y ..;-
,
.
.
~
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME: i?~~ A7,?/~
I'
,
Job. No.~/YbZ.
ADDRESS: ?7~' ~~t;.-'~?/~
LOCATION OF PROPOSED BUILDING SITE:
Street Address: "7:00 ${ y~-zyc::..
Plat Name: _J";;>v99~,5"-~/ -- Tax Lot Number: t:!Z?l:' ~~
PHONE: 7'//-'7'///
STATE:~ZIP: ?J?'h_/
1. DEVELPPMENT TVP~ (Check appropriate dwelling(s). SDC calculations and dwelling I
ype definitions are on the back.)
A. Sinale-FAmilv Detached
~ngle Family home
. NO. OF UNITS /
I
B. Sinale-FAmilv AttAcheQ
K Manufactured home not in a park
,-
X $1,000 per unit = $ / p:' ~ e::- a
, '
NO. OF UNITS
X $924 per unit = $
C. Multi-Familv Aoartmen\
NO. OF UNITS
X $692 per unit = $
D. Manufacturerl Home PArk
NO. OF UNITS
X $699 per 'unit - $
WILLAMALANE SDC $
2. SDC CREDIT (if applicable) SDC-payer must furnish proof of
Willamalane Credil approval. See SDC Credit Worksheet. $
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit) $
'a~.
D'eve.kffitf(ent Services Department
City oftSpringfield
e:y I /t; I ~
Date